Healthcare Provider Details

I. General information

NPI: 1912057555
Provider Name (Legal Business Name): THUY XUAN DAO PRIEST OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 BRIGHTON HENRIETTA TOWN LINE RD EYE SERVICES
ROCHESTER NY
14623-2532
US

IV. Provider business mailing address

1850 BRIGHTON HENRIETTA TOWN LINE RD C/O CREDENTIALING DEPARTMENT
ROCHESTER NY
14623-2532
US

V. Phone/Fax

Practice location:
  • Phone: 585-452-8181
  • Fax: 585-452-8183
Mailing address:
  • Phone: 585-452-8114
  • Fax: 585-452-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV5361
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License NumberTUV5361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: